Marlie, an American who has health insurance through her employer, wants to have some elective cosmetic surgery done. She is horrified by the out-of-pocket expenses she would incur were she to get it done in the United States, but her insurance provider also works with surgeons in other countries, where the cost of care is lower, and refers her to a surgeon in Thailand. Marlie is best described as engaging in in order to get the surgery she wants.